Gout- from a primary care perspective

Gout is a type of inflammatory arthritis which can cause recurrent episodes of acute pain and joint inflammation. Epidemiological studies show it is 2-6 folds more common in men than in women. It is caused by raised serum uric acid levels which, when gets deposited in joints and tissues can cause significant pain and morbidity. Untreated gout can cause permanent joint damage. Hyperuricemia can also cause urate nephropathy and renal stones. It is associated with other cardiovascular diseases. Risk factors include male sex, obesity, genetics, purine rich food, alcohol, certain medications, chronic kidney disease, hypertension and diabetes mellitus. Gout can present as rapid onset pain and swelling of any joint, predominantly of the first metatarsophalangeal joint. Tophi can present as painless, nodules on extensor surfaces of joints or other body parts. Diagnosis is by identification of uric acid crystals in joint fluid aspirates. Management involves modifying risk factors, treatment of acute attacks using non- steroidal anti-inflammatory drugs, colchicine, steroids and long-term prophylaxis medications. Prophylaxis is based on treat to target approach and involves urate lowering drugs like allopurinol, febuxostat. There are other newer drugs available in secondary care. Despite the availability of effective prophylactic medications to lower uric acid levels, the prevalence of gout is increasing. It stresses the importance of patient education as well as initiating urate lowering drugs in patients presenting with recurrent attacks and those with other co-morbid risk factors. The aim of this article is to provide an overview of gout and its management in primary care. We, as authors also highlight the importance of patient education and empowerment in better understanding of their disease and adherence to long term management. We also strongly advocate starting urate lowering therapy for at risk patients by primary care physicians. This will not only prevent future gout attacks, but also reduces long term complications like joint damage, tophi, renal stones, renal impairment and reduce the risks of cardiovascular disease. Key words: Gout, inflammatory arthritis, hyperuricemia, urate lowering therapy, prophylaxis